The overall goal of this study is to evaluate the distribution and determinants of hepatitis B vaccine use and compliance in Iowa hospitals and among Iowa health care workers. This study is designed to identify institutional, occupational and behavioral variables among health care workers that impact on their practice of effective preventive health measures, using compliance with the hepatitis B vaccine as the paradigm. In the first stage, a longitudinal survey of Iowa health care institutions will be performed over a two-year period to define the rates and distribution of hepatitis B vaccine compliance following implementation of a federal mandate for vaccination. Levels of institutional compliance with OSHA's Bloodborne Pathogens Rule will be categorized and their effect on vaccine compliance and occupational exposures measured. Vaccine compliance rates among health care workers in different job categories will be determined in institutional assessments at 12 and 24 months after the initial survey. In the second stage of the study, a stratified random sample of 15 health care workers in each of three occupational categories at 30 general hospitals will be studied to investigate attitudes about vaccination, the effectiveness of different types of vaccination programs, as well as the effect of OSHA's Bloodborne Pathogens Rule. Data from individual interviews will be used to evaluate the relative utility of two theoretical behavioral models in predicting health care worker vaccine compliance. Multivariate models will be developed to predict individual and institutional compliance. Additionally, the relative importance of institutional versus individual factors in determining individual hepatitis B vaccine compliance will be evaluated. In the third year of the study, these models will be validated prospectively in a second sample of health care workers and unstudied hospitals and used to identify an effective vaccine implementation program for hospitals and other health care facilities. The University of Iowa is a superb location in which to conduct the proposed study. Drs. Schwartz, Wenzel, and Rohrer are nationally recognized experts in occupational disease, nosocomial infections, and health policy, respectively. Additionally, there are close collaborative ties between the Departments of Internal Medicine, Preventive Medicine and Environmental Health, and Hospital and Health Administration which will serve to further enhance the success and the future development of the candidate and project.